Esketamine Brand Name– SPRAVATO
What is Esketamine
Esketamine is the active isomer of ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist.
Esketamine is a nasal spray that is used as an adjunct to an oral antidepressant for treatment-resistant depression in adults with major depressive disorder (MDD).
Treatment-resistant patients are defined as those who have failed 2 or more standard antidepressant treatments.
Esketamine is the first NMDA antagonist to receive FDA approval for major depression. Patients, the treating prescriber, and dispensing pharmacies must be enrolled in the Spravato REMS program.
The doses must be administered in a healthcare setting, with patients monitored for at least 2 hours after dosing due to the potential for serious adverse outcomes resulting from dissociative symptoms, sedation, or abuse.
Because the sedation caused by esketamine can be delayed or prolonged, patients should be instructed to avoid driving or engaging in other tasks requiring complete mental alertness until the day after treatment.
Esketamine, like ketamine, has the potential for abuse, and the benefit versus risk of esketamine should be determined in patients at risk for abuse, misuse, or diversion of the drug.
Indications
- depression
For the treatment of treatment-resistant depression in conjunction with an oral antidepressant
Side Effects
- anxiety
- confusion
- constipation
- depression
- diarrhea
- dissociation
- dizziness
- drowsiness
- dysarthria
- dysgeusia
- dysphoria
- euphoria
- hallucinations
- headache
- hyperhidrosis
- hypertension
- hypertensive crisis
- hypoesthesia
- impaired cognition
- increased urinary frequency
- insomnia
- lethargy
- loss of consciousness
- memory impairment
- myasthenia
- nasal dryness
- nausea
- physiological dependence
- psychological dependence
- psychomotor impairment
- sinus tachycardia
- suicidal ideation
- throat irritation
- tolerance
- tremor
- vertigo
- vomiting
- xerostomia
Monitoring Parameters
- blood pressure
- neurologic function
Contraindications
- alcoholism
- aneurysm
- arteriovenous malformation
- breast-feeding
- cardiac disease
- cerebrovascular disease
- children
- CNS depression
- coadministration with other CNS depressants
- dissociation
- driving or operating machinery
- encephalopathy
- geriatric
- hepatic disease
- hypertension
- hypertensive crisis
- intracranial bleeding
- ketamine hypersensitivity
- loss of consciousness
- pregnancy
- prevention of pregnancy
- psychosis
- requires a specialized care setting
- schizophrenia
- substance abuse
- suicidal ideation
Interactions
- Acetaminophen; Aspirin, ASA; Caffeine
- Acetaminophen; Butalbital
- Acetaminophen; Butalbital; Caffeine
- Acetaminophen; Butalbital; Caffeine; Codeine
- Acetaminophen; Caffeine
- Acetaminophen; Caffeine; Dihydrocodeine
- Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
- Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
- Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
- Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
- Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
- Acetaminophen; Codeine
- Acetaminophen; Dextromethorphan; Doxylamine
- Acetaminophen; Diphenhydramine
- Acetaminophen; Hydrocodone
- Acetaminophen; Oxycodone
- Acetaminophen; Pentazocine
- Acetaminophen; Propoxyphene
- Acetaminophen; Tramadol
- Alfentanil
- Alprazolam
- Amitriptyline
- Amitriptyline; Chlordiazepoxide
- Amobarbital
- Amoxapine
- Amphetamine
- Amphetamine; Dextroamphetamine
- Amphetamines
- Apomorphine
- Aripiprazole
- Armodafinil
- Asenapine
- Aspirin, ASA; Butalbital; Caffeine
- Aspirin, ASA; Butalbital; Caffeine; Codeine
- Aspirin, ASA; Caffeine; Dihydrocodeine
- Aspirin, ASA; Caffeine; Orphenadrine
- Aspirin, ASA; Carisoprodol
- Aspirin, ASA; Carisoprodol; Codeine
- Aspirin, ASA; Oxycodone
- Atropine
- Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
- Atropine; Difenoxin
- Atropine; Diphenoxylate
- Atropine; Edrophonium
- Atropine; Hyoscyamine; Phenobarbital; Scopolamine
- Azelastine
- Azelastine; Fluticasone
- Baclofen
- Barbiturates
- Belladonna Alkaloids; Ergotamine; Phenobarbital
- Belladonna; Opium
- Benzodiazepines
- Benzphetamine
- Brexpiprazole
- Brompheniramine
- Brompheniramine; Carbetapentane; Phenylephrine
- Brompheniramine; Dextromethorphan; Guaifenesin
- Brompheniramine; Dextromethorphan; Phenylephrine
- Brompheniramine; Guaifenesin; Hydrocodone
- Brompheniramine; Hydrocodone; Pseudoephedrine
- Brompheniramine; Pseudoephedrine
- Buprenorphine
- Buprenorphine; Naloxone
- Butabarbital
- Butorphanol
- Caffeine
- Caffeine; Ergotamine
- Cannabidiol
- Capsaicin; Metaxalone
- Carbetapentane; Chlorpheniramine
- Carbetapentane; Chlorpheniramine; Phenylephrine
- Carbetapentane; Diphenhydramine; Phenylephrine
- Carbidopa; Levodopa
- Carbidopa; Levodopa; Entacapone
- Carbinoxamine; Hydrocodone; Phenylephrine
- Carbinoxamine; Hydrocodone; Pseudoephedrine
- Cariprazine
- Carisoprodol
- Cetirizine
- Cetirizine; Pseudoephedrine
- Chloral Hydrate
- Chlordiazepoxide
- Chlordiazepoxide; Clidinium
- Chlorpheniramine
- Chlorpheniramine; Codeine
- Chlorpheniramine; Dextromethorphan
- Chlorpheniramine; Dextromethorphan; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
- Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Hydrocodone
- Chlorpheniramine; Hydrocodone; Phenylephrine
- Chlorpheniramine; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Phenylephrine
- Chlorpheniramine; Pseudoephedrine
- Chlorpromazine
- Chlorthalidone; Clonidine
- Chlorzoxazone
- Clemastine
- Clomipramine
- Clonazepam
- Clonidine
- Clorazepate
- Clozapine
- Codeine
- Codeine; Guaifenesin
- Codeine; Phenylephrine; Promethazine
- Codeine; Promethazine
- Cyclobenzaprine
- Cyproheptadine
- Dantrolene
- Desipramine
- Deutetrabenazine
- Dexmedetomidine
- Dexmethylphenidate
- Dextroamphetamine
- Dextromethorphan; Diphenhydramine; Phenylephrine
- Dextromethorphan; Promethazine
- Diazepam
- Diethylpropion
- Dihydrocodeine; Guaifenesin; Pseudoephedrine
- Dimenhydrinate
- Diphenhydramine
- Diphenhydramine; Hydrocodone; Phenylephrine
- Diphenhydramine; Ibuprofen
- Diphenhydramine; Naproxen
- Diphenhydramine; Phenylephrine
- Doxepin
- Doxylamine
- Doxylamine; Pyridoxine
- Droperidol
- Enflurane
- Entacapone
- Estazolam
- Eszopiclone
- Ethanol
- Etomidate
- Fentanyl
- Flibanserin
- Fluoxetine; Olanzapine
- Fluphenazine
- Flurazepam
- Fospropofol
- Gabapentin
- General anesthetics
- Guaifenesin; Hydrocodone
- Guaifenesin; Hydrocodone; Pseudoephedrine
- Guanfacine
- Haloperidol
- Halothane
- Homatropine; Hydrocodone
- Hydrochlorothiazide, HCTZ; Methyldopa
- Hydrocodone
- Hydrocodone; Ibuprofen
- Hydrocodone; Phenylephrine
- Hydrocodone; Potassium Guaiacolsulfonate
- Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
- Hydrocodone; Pseudoephedrine
- Hydromorphone
- Hydroxyzine
- Ibuprofen; Oxycodone
- Iloperidone
- Imipramine
- Isocarboxazid
- Isoflurane
- Ketamine
- Levocetirizine
- Levodopa
- Levorphanol
- Lisdexamfetamine
- Lofexidine
- Lorazepam
- Loxapine
- Lurasidone
- Maprotiline
- Meclizine
- Melatonin
- Meperidine
- Meperidine; Promethazine
- Mephobarbital
- Meprobamate
- Metaxalone
- Methadone
- Methamphetamine
- Methocarbamol
- Methohexital
- Methyldopa
- Methylphenidate
- Metoclopramide
- Midazolam
- Mirtazapine
- Modafinil
- Molindone
- Monoamine oxidase inhibitors
- Morphine
- Morphine; Naltrexone
- Nalbuphine
- Nefazodone
- Nortriptyline
- Olanzapine
- Opiate Agonists
- Orphenadrine
- Oxazepam
- Oxycodone
- Oxymorphone
- Paliperidone
- Pentazocine
- Pentazocine; Naloxone
- Pentobarbital
- Perampanel
- Perphenazine
- Perphenazine; Amitriptyline
- Phendimetrazine
- Phenelzine
- Phenobarbital
- Phentermine
- Phentermine; Topiramate
- Phenylephrine; Promethazine
- Pimavanserin
- Pimozide
- Pramipexole
- Pregabalin
- Primidone
- Prochlorperazine
- Promethazine
- Propofol
- Propoxyphene
- Protriptyline
- Quazepam
- Quetiapine
- Ramelteon
- Rasagiline
- Remifentanil
- Risperidone
- Ropinirole
- Rotigotine
- Safinamide
- Scopolamine
- Secobarbital
- Selegiline
- Sevoflurane
- Skeletal Muscle Relaxants
- Sodium Oxybate
- Solriamfetol
- Sufentanil
- Suvorexant
- Tapentadol
- Tasimelteon
- Temazepam
- Tetrabenazine
- Thalidomide
- Thiopental
- Thioridazine
- Thiothixene
- Tizanidine
- Tolcapone
- Tramadol
- Tranylcypromine
- Trazodone
- Triazolam
- Tricyclic antidepressants
- Trifluoperazine
- Trimipramine
- Valerian, Valeriana officinalis
- Valproic Acid, Divalproex Sodium
- Zaleplon
- Ziprasidone
- Zolpidem
